Expert: Susan Tannenbam - 2/11/2004

Question
Hello Susan,

I am desperately interested the methods you use to overcome TMJ.  I've had this condition for about two years now (I'm currently 25), and at times the pain is beyond unbearable.  My jaw pops on both sides, causing headaches and discomfort eating.  Last time I visited my dentist, he mentioned that it seemed that my jaw may still be growing, or that it might somehow be related to my asthma (mouth breathing, I suppose).  I've also been researching remedies on the internet, ranging from "fix-it-yourself" guidebooks for $19.95 to risky and invasive surgey costing up to $15,000.  I would like your opinion on this along with any suggestions you might have for me.  Your help is greatly appreciated.

Answer
Hi Josh,  I can't give any medical advice but I will tell you what I did in the months leading up to the time when my pain went away.  I did not have popping, just a lot of pain on the side of my face, in the chewing muscles and jaw joints.  My teeth hurt and I felt like if I ate hard food, it would do further damage to my condition.  i later learned that the pain in my neck, head, teeth, gums, was actually REFERRED pain, coming from the tight neck muscles and other muscles that become tight, from clenching and grinding at night. Your headaches are most likely referrred pain from other muscles in your body such as the neck muscles. Here is what I did:
l.  A nightguard (sometimes called a splint) is a MUST.  I have one that fits over the bottom teeth, and it's hard acrylic.  
2. Any form of aerobic exercise is GREAT as it releases
endorphins which help reduce pain.

3. An antidepressant is also effective , often, for pain, even though you might not "feel depressed".  I was depressed because of the pain.  The AD medication helped a lot to reduce the cycle of pain, and I was able to wean off it after about a year or so.  I know you might be turned off to the use of meds like this, but in my mind, it's well worth it.  Also, a muscle relaxant like Flexeril is great.  I always have a med like that on hand.  A lot of my pain was caused by tight muscles, so this helped.  I used Advil TOO MUCH and later learned that overuse of it can actually make the pain WORSE.  But you can use it sometimes.
4  Accupuncture helped me tremendously, but only after I experimented with several practitioners and found a good one.  Don't be discouraged :  it takes a little time to find a good one.  I was told a medical doctor that does accupunture is the best person to use, althought mine was not a doctor.
5. The Alpha-Stim 100, which you can buy on alpha-stim.com helped me so much.  If you buy it, and you want to know how I use it, let me know.  It's expensive but worth every penny..  A doctor told me it is safe and recommended it.
6. Relaxation exercises:  Any tape you like, that puts you in a state of relaxation, is good.  I used to PANIC so much  when I felt the paink, and this is the WORST thing to do, even tho it's a natural reaction to pain!  You must DO THE OPPOSITE, which is to RELAX, and sit quietly, and just sort of accept the pain, and OBSERVE it, and then RELAX all the muscles in the face and jaw.  I know this sounds questionable to most people and even to me, at first, which is why I didn't do it for a long time, but IT REALLY WORKS!  For some reason, if you pay attention to the pain and accept it, while sitting in a quiet relaxed state, your body just responds in a positive way.  I hated when pp would say that pain is"In your head" but there's a lot of truth to this, in that you can use your mind to  affect the discomfort  it in a positive way.  Remember this:  PAIN FEEDS ON PANIC AND ANXIETY!  Don't feed it this, and you'll see what a difference it makes.  And don't think it's a hopeless situation:  my pain was so SEVERE  that it put me in such a horrible state of mind, and I was so negativeabout it, but when I changed from fear to acceptance, and told myself "this will pass", it did.
7. TMJ gel - you need a prescription from a dentist that deals with TMJ.  It numbs the pain - it's topically applied.
8.I also used TMJ pads that stick on the muscles that hurt, and are medicated (prescription needed)
9.Food-NEVER NEVER NEV ER eat bagels, chew gum (EVER AGAIN), carrots, hard or chewy bread (for now).  Most other food is soft enough to eat.  I eat everything now,except for Bagels and gum. (they will set off a new cycle of pain if I do!)
10.  Physical therapy,  It took me awhile to find a good P.T.  She works in NYU Dental Schoool, division of TMJ.  B y the way, getting in touch with a dental school is a good way of finding out who the best pp are to help you.
If you live in the New York area, I'll be happy to share with you exactly who I use.
11.Ultrasound, I found, was the best form of therapy for the condition.  It 's done by a physical therapist.  My dentist also did it for me (he's GREAT-NY area)
12.  Jaw  exercises: l. open the jaw wide, hold a minute, close it, and repeat.  This is great for the pain, as it stretches out the muscle tightness. 2. Press with your knuckle or a very blunt object, into the side of the cheek where the muscle hurts, very hard, and release. repeat as many times as tolerable.  This hurts at first but it works wonders to break up the muscle.  THIS IS NOT AN EXERCISE TO DO DIRECTLY OVER THE JAW JOINT, JUST ON THE CHEWING MUSCLES. (they hurt me, I don't know about you)  3.  Hold your head to the side, over to the shoulder, hold one minute, repeat on the other side, and repeat the whole thing again.  The neck muscles are tight from this condition andthis helps a lot.  I actually should have mentioned these exercises first in this letter, as they did SO MUCH GOOD.

I  don't know anything about surgery, so I can't, as I said, advise you on that.  if you have any more questions you can email me at suelliot2@earthlink.net
I know how difficult this thing can be.  But hang in there: if my extreme pain went away, so will yours.  Good luck.